| NPI | 1356615488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MN 1-12-10041) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: 1-12-10041) |
| 103K00000X Behavior Analyst (Licence: WI 1-12-10041) | |
| Enumeration Date | 2012-03-07 |
| Last Update Date | 2024-05-03 |